Results and Outcomes of Combined Cross Screw and Ilizarov External Fixator Frame in Ankle Fusion.

Ankle fusion is a treatment option for end-stage ankle arthritis. Fusion site stability and optimal foot positioning are crucial parameters. We present the results of our double fixation technique, combining both cross-screw fixation and Ilizarov external fixator frame via transmalleolar approach.

Gunshot and blast injuries of the extremities: a review of 45 cases.

Gunshot wounds and blast injuries constitute a major public health problem, as the increasing availability of firearms and explosives in conjunction with increasing violence in the city setting have brought this reality into civilian life. Extremities are most commonly involved; therefore, orthopedic surgeons should be trained to manage these types of injuries. Complete and accurate assessment of the injury itself is of great importance, as it will determine the severity and the risk of patients.

Outcome of Percutaneous Fixation of Acute Achilles Tendon Ruptures.

Background: Conservative treatment of an acute Achilles rupture remains a viable and acceptable option as does surgical fixation, with open and percutaneous repair consisting the main operative techniques. The purpose of this study was to compare the outcomes and complication rates of open versus percutaneous surgical procedures.

Methods: From 2009 to 2016, 131 patients were admitted to our department with clinically and radiologically confirmed acute Achilles tendon ruptures.

Salvage of the Foot for Recurrent Malignant Peripheral Nerve Sheath Tumor.

Malignant peripheral nerve sheath tumors are rare soft tissue tumors accounting for 3% to 10% of all soft tissue tumors. They are strongly related to neurofibromatosis type 1, an autosomal dominant disease, and are characterized by aggressive biologic behavior, high local recurrence rates, and frequent metastases. Although the major nerves of the lower extremities are a common location of these tumors, scarce cases have been reported of malignant peripheral nerve sheath tumors involving the interdigital nerves of the foot.

A Two-stage procedure for the treatment of a neglected posterolateral knee dislocation: Gradual reduction with an Ilizarov external fixator followed by arthroscopic anterior and posterior cruciate ligament reconstruction.

Background: Neglected knee dislocations are extremely uncommon and their management cannot be evidence-based since only a few case reports have been published describing different treatment methods. We present the case of a young man with a neglected posterolateral knee dislocation and a concomitant sciatic nerve injury.

Methods: A two-stage treatment strategy with gradual reduction using the Ilizarov technique and subsequent arthroscopic anterior and posterior cruciate ligament reconstruction was followed.

Evaluation of TLICS for thoracolumbar fractures.

Purpose: Thoracolumbar Injury Classification and Severity Score (TILCS), facilitates the communication between physicians, and guides to treatment decision with better outcome. A composite injury severity score is calculated from these characteristics stratifying patients into operative and non-operative treatment. Aim of this study is to identify the effectiveness of TLICS scoring for thoracolumbar vertebral fractures without neurological deficits and the efficacy of conservative treatment in patients with TILCS 4.

Combined use of Ilizarov external fixation and Papineau technique for septic pseudoarthrosis of the distal tibia in a patient with diabetes mellitus.

The surgical treatment of open pilon fractures has a high complication rate especially in diabetic patients. In this article, we present a case of an infected tibial non-union after an open reduction and internal fixation in a diabetic patient, treated with Ilizarov external fixation combined with Papineau technique. Combined use of external fixation and Papineau technique can provide an alternative option for the treatment of septic pseudoarthrosis of the distal tibia.

Papineau debridement, Ilizarov bone transport, and negative-pressure wound closure for septic bone defects of the tibia.

Purpose: Ilizarov pioneered bone transport using a circular external fixator. Papineau described a staged technique for the treatment for infected pseudarthrosis of the long bones. This article presents a single-stage Papineau technique and Ilizarov bone transport, and postoperative negative-pressure wound dressing changes for septic bone defects of the tibia.

The reverse sural fasciocutaneous flap for the treatment of traumatic, infectious or diabetic foot and ankle wounds: A retrospective review of 16 patients.

The authors present their experience with the use of sural fasciocutaneous flaps for the treatment of various soft tissue defects in the lower limb. This paper is a review of these flaps carried out between 2003 and 2008. The series consists of 16 patients, 11 men and 5 women with an average age of 41 years (17-81) and with a follow-up period between 2 and 7 years.

The use of Papineau technique for the treatment of diabetic and non-diabetic lower extremity pseudoarthrosis and chronic osteomyelitis.

The treatment of 31 consecutive adult patients, ages 25-67 years with chronic draining osteomyelitis (12 cases) or infected pseudarthrosis (19 cases) by the Papineau technique was retrospectively reviewed. The initial injury was an open fracture in 24 patients and a closed fracture in 7 patients. In all cases an Ilizarov circular external fixation device was used for the stabilization of the fracture or for bone lengthening.

Distal posterior tibial artery perforator flaps for the management of calcaneal and Achilles tendon injuries in diabetic and non-diabetic patients.

Management of Achilles tendon and heel area defects is a common challenge for the reconstructive surgeon due to the lack of soft tissue availability in that region. In this article, we present our experience in covering these defects by using the distal perforator propeller flaps based on the posterior tibial artery. Perforator flaps are based on cutaneous, small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to reach the skin.

The use of a combined bipedicled axial perforator based fasciocutaneous flap for the treatment of a traumatic diabetic foot wound: a case report.

The axial and perforator vascularised fasciocutaneous flaps are reliable and effective treatment methods for covering lower limb post-traumatic, septic, Charcot, and diabetic foot wounds. The authors describe the unique utilisation of a hybrid flap as an axial-perforator flap combination for the treatment of a traumatic diabetic foot wound.

Combined distraction osteogenesis and Papineau technique for an open fracture management of the distal lower extremity.

Despite modern surgical techniques and advanced antimicrobial therapy, open lower-extremity fracture management and osteomyelitis remain a challenge for reconstructive surgeons. Posttraumatic composite bone and soft tissue defects are usually the result of high-energy trauma and are often associated with concomitant injuries, therefore making complex reconstruction more difficult. This article presents a case report of an open distal tibial fracture managed by a simultaneous distraction osteogenesis and Papineau technique with a long term follow-up and literature review.

Surgical management of a diabetic calcaneal ulceration and osteomyelitis with a partial calcanectomy and a sural neurofasciocutaneous flap.

The treatment of calcaneal osteomyelitis in diabetic patients poses a great challenge to the treating physician and surgeon. The use of a distally based sural neurofasciocutaneous flap after an aggressive debridement of non-viable and poorly vascularized tissue and bone that is combined with a thorough antibiotic regimen provides a great technique for adequate soft tissue coverage of the heel. In this case report, the authors describe the aforementioned flap as a versatile alternative to the use of local or distant muscle flaps for diabetic patients with calcaneal osteomyelitis and concomitant large wounds.

A case report of a simultaneous local osteochondral autografting and ankle arthrodiastasis for the treatment of a talar dome defect.

Talar osteochondral defects (OCDs) are a challenge for treating physicians because they frequently are missed or diagnosed incorrectly, often resulting in severe degenerative arthritis of the ankle joint. Surgical intervention becomes a viable option in the presence of larger OCDs associated with loose bodies or osteochondral lesions that have failed conservative treatment. The successful use of autologous osteochondral autograft in the knee has promoted the applicability in the ankle.

Combined medial displacement calcaneal osteotomy, subtalar joint arthrodesis, and ankle arthrodiastasis for end-stage posterior tibial tendon dysfunction.

Combining an ankle arthrodiastasis with a medial displacement calcaneal osteotomy and a subtalar joint arthrodesis offers surgeons a joint-sparing procedure for young and active patients who have end-stage posterior tibial tendon dysfunction and ankle joint involvement. An isolated subtalar joint arthrodesis or triple arthrodesis combined with an ankle arthrodiastasis is an option that can be used in certain case scenarios. Delaying the need for a joint destructive procedure through an ankle arthrodiastasis, however, may have a great impact in the near future, as advancements are underway to improve the use of ankle endoprosthesis.

Alternatives to ankle implant arthroplasty for posttraumatic ankle arthrosis.

Various surgical options beyond implant arthroplasty are available to treat posttraumatic ankle arthrosis. Conservative options are usually employed in combination and include the use of nonsteroidal anti-inflammatories, bracing, and orthoses, as well as injections of intra-articular corticosteroid and hyaluronic acid. If these conservative treatments fail, surgical intervention can be entertained.

Trunk asymmetry and handedness in 8245 school children.

The aim of this report is the appraisal of a possible correlation of trunk asymmetry assessed with a scoliometer and lateralization of the brain as expressed by handedness in a school aged population. Many (8245) students (4173 girls and 4072 boys), 6-18 years of age were examined. A checklist was completed for each student including handedness and trunk asymmetry.

Current concepts and techniques in posttraumatic arthritis.

Posttraumatic arthrosis is a commonly encountered clinical problem, but the pathoetiology of its development is not yet clarified. Many contributing mechanical biologic factors interplay with the traumatic event that necessarily precedes the posttraumatic syndrome. New biologic concepts involving the ability of the cartilage to repair and how such healing can be promoted are being realized in new modalities of treatment.

Current concepts in delayed bone union and non-union.

Healing of a fracture is a continuous process that involves various types of histologic regeneration at different sites. This article describes current approaches to managing delayed union and non-union of fracture.

The use of Ilizarov technique and other types of external fixation for the treatment of intra-articular calcaneal fractures.

Treatment of severely comminuted calcaneal fractures with soft tissue compromise is still a controversial issue among surgeons. Complications of open reduction internal fixation have been well reported in the literature with a fairly high incidence of posttraumatic osteoarthritis of the subtalar joint, symptomatic hindfoot stiffness (especially when fixed in varus), wound dehiscence, and potential for the development of osteomyelitis caused by the extensive soft tissue trauma inherent with these injuries. For these reasons, closed treatment techniques using minimally invasive reduction procedures with application of ring-type fine-wire external fixation have recently gained popularity.

Midfoot fractures.

Fractures of the midfoot are uncommon because of the constrained configuration of multiple articular surfaces, which is augmented by capsular attachments and strong ligaments and tendons. Injury patterns usually involve more than one structure, although isolated fractures, dislocations, and sprains can occur. The key to optimal treatment of midfoot fractures is a high index of clinical suspicion because of their rareness.